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Background <p>Acute antibody-mediated cardiac allograft rejection (AMR) can lead to SCAI Stage D cardiogenic shock, frequently necessitating escalation to extracorporeal membrane oxygenation support. However, biventricular Impella (BiPella), configured with Impella 5.5 and Impella RP Flex, may offer an alternative, less invasive cardiac unloading and support.</p> Case Presentation <p>We present a 28-year-old male nine-months post-heart transplantation who developed refractory shock from AMR after immunosuppression nonadherence. Hemodynamic instability and elevated filling pressures prompted emergent initiation of simultaneous Impella 5.5 and Impella RP Flex support. Over two weeks, cardiac function improved significantly for BiPella removal and discharge.</p> Conclusions <p>In select patients, BiPella may serve as a less invasive alternative to venoarterial extracorporeal membrane oxygenation support in rejection-associated biventricular failure, with potential advantages for substantial ventricular unloading, early mobilization, and bridging to recovery.</p>

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Biventricular impella support in acute antibody-mediated cardiac allograft rejection with severe hemodynamic compromise

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月10日

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  • Ye In Christopher Kwon,
  • Kelli Fox,
  • Jay Patel,
  • Richard Cooke,
  • Hamang Patel,
  • Inna F. Tchoukina,
  • Krishnasree Rao,
  • Melissa Smallfield,
  • Keyur B. Shah,
  • Vigneshwar Kasirajan,
  • Zubair A. Hashmi,
  • Josue Chery

摘要

Background

Acute antibody-mediated cardiac allograft rejection (AMR) can lead to SCAI Stage D cardiogenic shock, frequently necessitating escalation to extracorporeal membrane oxygenation support. However, biventricular Impella (BiPella), configured with Impella 5.5 and Impella RP Flex, may offer an alternative, less invasive cardiac unloading and support.

Case Presentation

We present a 28-year-old male nine-months post-heart transplantation who developed refractory shock from AMR after immunosuppression nonadherence. Hemodynamic instability and elevated filling pressures prompted emergent initiation of simultaneous Impella 5.5 and Impella RP Flex support. Over two weeks, cardiac function improved significantly for BiPella removal and discharge.

Conclusions

In select patients, BiPella may serve as a less invasive alternative to venoarterial extracorporeal membrane oxygenation support in rejection-associated biventricular failure, with potential advantages for substantial ventricular unloading, early mobilization, and bridging to recovery.